tag:theconversation.com,2011:/us/topics/medical-studies-37006/articlesmedical studies – The Conversation2017-04-27T20:04:41Ztag:theconversation.com,2011:article/759182017-04-27T20:04:41Z2017-04-27T20:04:41ZWhy brain stimulation isn’t what it’s cracked up to be<figure><img src="https://images.theconversation.com/files/166782/original/file-20170426-2838-rtgqtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">About half of studies of some types of brain stimulation cannot be reproduced. So, how do we know if these work?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/521251375?src=3ExGRfV8-B3WHzPbsBaQuw-1-7&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Interest in <a href="https://en.wikipedia.org/wiki/Transcranial_direct-current_stimulation">electrical brain stimulation</a> has skyrocketed in recent years, both in the <a href="https://theconversation.com/brain-stimulation-offers-hope-for-depression-but-dont-try-it-at-home-31625">popular</a> <a href="https://theconversation.com/brain-stimulation-is-getting-popular-with-gamers-is-it-time-to-regulate-it-66845">media</a> and <a href="http://www.cell.com/neuron/abstract/S0896-6273(14)00389-4">scientific literature</a>. </p>
<p>Scientists and clinicians are using the non-invasive and cheap technique to treat various <a href="http://www.sciencedirect.com/science/article/pii/S1388245716306344">neurological and psychiatric disorders</a>, including depression, epilepsy and addiction. The US military is researching whether it <a href="http://www.bbc.com/future/story/20140603-brain-zapping-the-future-of-war">improves learning and attention</a>. And those who train elite athletes <a href="http://www.nature.com/news/brain-doping-may-improve-athletes-performance-1.19534">can see its potential</a> to enhance performance.</p>
<p>But <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175635">our research shows</a> the evidence to back electrical brain stimulation varies in quality, and the results are commonly not reproduced in other studies. Our survey also unearthed the lengths to which some researchers go to to present their findings in the best light.</p>
<h2>What is electrical brain stimulation?</h2>
<p>The type of electrical brain stimulation we studied is transcranial direct-current stimulation. This is when a small electric current is applied to the brain for 20 to 30 minutes. Electrodes are placed on the patient’s head, and some of the current passes through the skull to the brain. </p>
<p>It is thought this alters brain function mainly by inducing persistent changes in the excitability of neurones.</p>
<p>This isn’t to be confused with <a href="https://www.beyondblue.org.au/the-facts/depression/treatments-for-depression/medical-treatments-for-depression/electroconvulsive-therapy-(ect)">electroconvulsive therapy</a>, which uses currents hundreds of times larger. This induces a seizure.</p>
<h2>What we did</h2>
<p>We used an online survey to ask researchers if they could reproduce published findings related to electrical brain stimulation. We invited all researchers who served as corresponding authors on a published scientific paper on electrical brain stimulation in humans to do so. </p>
<p>In all, 976 researchers from all over the world were invited to answer the question of whether they could reproduce published electrical brain stimulation effects. </p>
<p>We also asked whether researchers used, but didn’t report, questionable research practices in their own research – such as fiddling with statistics to make them look more favourable and selectively reporting results. And we asked if they thought other researchers used these questionable techniques, and whether they should be reported in publications. </p>
<p>To check what researchers actually do, we audited a random selection of 100 publications featuring research on electrical brain stimulation. We looked to see if they admitted to the dodgy practices in their publications.</p>
<h2>What we found</h2>
<p>For the two most popular types of electrical brain stimulation (anodal and cathodal stimulation), only 45 to 50% of researchers routinely reproduced published findings.</p>
<p>Some researchers were aware of others who handpicked which experimental conditions (36%) and which results (41%) to publish. They also knew researchers who manipulated results by excluding data based on a gut feeling (20%) and fiddling with the statistics (43%).</p>
<p>As expected, fewer researchers admitted to personally using these types of shady research practices. Still, 25% admitted to adjusting statistical analysis to optimise results – namely <a href="https://theconversation.com/how-we-edit-science-part-2-significance-testing-p-hacking-and-peer-review-74547">p-hacking</a>, when researchers manipulate the statistics to make results appear more statistically significant than they might otherwise be.</p>
<p>Our research also revealed the difference between whether these questionable types of practices <em>should be</em> reported in research papers, and whether they <em>are</em>. Although 92% of respondents said all researchers should admit to the questionable practices in their publications, we found only two such admissions (2%) in our audit of published studies.</p>
<h2>So, what do we make of this?</h2>
<p>Meta-analyses, which are studies that pool results from several other studies, indicate electrical brain stimulation is effective in <a href="http://bjp.rcpsych.org/content/208/6/522">major depression</a>. But it isn’t in fibromyalgia (where people experience widespread pain without a known cause), food craving and overeating, Parkinson’s disease, and speech problems after a stroke.</p>
<p>Unfortunately, a general finding is that electrical brain stimulation studies are often of low quality and that, when present, therapeutic effects are often small. So, before you decide to strap electrodes to your head, speak to an informed health professional.</p>
<p>Poor reproducibility and bad science <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124">are not unique</a> to electrical brain stimulation research. Nor are these problems new. But <a href="https://theconversation.com/we-need-to-talk-about-the-bad-science-being-funded-61916">public funds are being wasted</a> on poorly conducted research that cannot be reproduced, which means the results are questionable. Such poor research is tarnishing the genuine efforts of researchers to improve human brain function.</p>
<p>The main reason researchers engage in questionable researcher practices is the continual pressure to <a href="https://theconversation.com/why-isnt-science-better-look-at-career-incentives-65619">publish scientific papers</a> to gain funding or to progress scientific careers. If results are statistically significant, researchers are <a href="http://science.sciencemag.org/content/345/6200/992">more likely to be published</a>. So, researchers may consciously, or unconsciously, resort to questionable or fraudulent research practices.</p>
<h2>What can we do about it?</h2>
<p>Awareness of bad science is on the rise – and <a href="https://www.nature.com/articles/s41562-016-0021">recommendations</a> and <a href="http://www.acmedsci.ac.uk/policy/policy-projects/reproducibility-and-reliability-of-biomedical-research/">guidelines are emerging</a> to deal with this. But there needs to be more education and true incentives for scientists to conduct better, reproducible science. </p>
<p>If not, some scientists will continue to do as they have always done. Incentives to improve the culture of research include promoting researchers who do more <a href="https://cos.io/">open science</a>, and funding projects that adhere to open science practices as well as those that attempt to replicate studies.</p>
<p>The responsibility to improve the quality of our science lies with research institutions and universities, <a href="http://www.nature.com/news/policy-nih-plans-to-enhance-reproducibility-1.14586">funding agencies</a>, scientific publishers and individual researchers.</p>
<p>Our goal of clinically useful brain stimulation techniques is a worthy one. But our progress is limited by findings of often variable and small effects currently reported, as well as the poor quality of some of the studies that claim any effects at all.</p><img src="https://counter.theconversation.com/content/75918/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Electrical brain stimulation is used to treat a range of conditions, from depression to epilepsy. But how confident can we be that it works?Martin Héroux, Senior Research Fellow, Neuroscience Research AustraliaColleen Loo, Professor of Psychiatry, UNSW SydneySimon Gandevia, Deputy Director, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/738252017-04-10T00:36:14Z2017-04-10T00:36:14ZMaximizers vs. minimizers: The personality trait that may guide your medical decisions – and costs<figure><img src="https://images.theconversation.com/files/163166/original/image-20170329-8597-62b1o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A suitable disposition helps the medicine go down. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/charlesonflickr/3926259585/in/photolist-6YX7bM-eezAL3-7L4M17-H3cM9-56GQ2T-Jcsog-JcsvK-2Fpbw2-pUbbhY-tKbd3-fb3upd-7h6LAG-5AmXEB-nCRq68-c9BtzG-8mhovR-Jcmvo-8dZbFR-6LL5ZB-98TizC-QsFKVk-74ADin-fMm7D2-7JekWW-dCC8Ac-ytPSs-Jcm7y-dUR18t-bAQy2x-qKcioo-oaK1Rs-bo9sQy-5EDnDa-6KnUKJ-iZkLPZ-dUBLrT-dzkMxn-jPpPBp-oYLAdr-owQxS-dmpbvA-dcTGtJ-29HnZx-rvMeJ4-8GSpnt-rcsYCD-a2cbaY-6PxGnk-A8zQK-bEPm7E">Cropped from charlesonflickr/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Do certain people want more medical care than others do? And, does that matter?</p>
<p>To consider this idea, start by answering the following question: Which of the paragraphs below describes you best?</p>
<p>“I prefer active medical interventions and being proactive about my health. I like doing things that may positively affect my health, like taking medicines, remedies, vitamins and/or getting optional medical procedures. If there is a health intervention that can be had, I will probably want to do it.”</p>
<p>OR</p>
<p>“If given the option, I would prefer to not take drugs or get tests or medical interventions. It’s not necessarily the case that I distrust doctors, I just prefer to watch and wait until it is clear that medical intervention is necessary. I go by the saying ‘If it isn’t broken, don’t fix it.’”</p>
<p>Your answer might have broad implications for your experiences in health care.</p>
<h2>Maximizers versus minimizers</h2>
<p>If you thought that the first paragraph described you best, then you fit the description of what we call a “medical maximizer,” someone who prefers active approaches to health care. </p>
<p>If you thought that the second paragraph described you best, then you are a “medical minimizer” who prefers a more passive approach. </p>
<p>In their 2011 book <a href="http://www.yourmedicalmind.com">“Your Medical Mind</a>,” physicians Jerome Groopman and Pamela Hartzband proposed, on the basis of their clinical experience, that medical maximizing versus minimizing is a stable trait that influences the way people approach health care across time and contexts. </p>
<p>My colleagues and I wanted to know whether medical maximizing versus minimizing could explain the different ways people use health care. We developed and validated a <a href="http://psycnet.apa.org/journals/hea/35/11/1276/">10-item questionnaire</a> that assesses a person’s maximizing or minimizing tendencies on a scale, from one (strong minimizing) to seven (strong maximizing). Across four studies involving over 2,400 participants, we found this difference predicts health care use across a range of medical interventions and health problems, from cancer screening preferences to vaccination. </p>
<p>You can <a href="https://missouripsych.az1.qualtrics.com/jfe/form/SV_bEL6UB74RiLD4Il">take the questionnaire here</a> to find out where you fall on the maximizing-minimizing scale. </p>
<h2>Why this trait matters</h2>
<p>There are two major barriers to optimizing health care and reducing expenditures in the U.S.</p>
<p>One problem is overutilization of health care resources, when people receive costly care that offers little in terms of health benefits – or might even cause harm. Overutilization is, <a href="http://jamanetwork.com/journals/jama/article-abstract/182076">by some estimates</a>, one of the most important contributors to high health care costs in the United States. Initiatives such as <a href="http://www.choosingwisely.org">Choosing Wisely</a> – a campaign from the American Board of Internal Medicine to promote conversations between patients and doctors about choosing the right care – help highlight the fact that many commonly used tests and treatments have questionable value. </p>
<p>On the other hand, underutilization is also a major problem, in which people do not receive care that actually could provide a benefit. For example, when people do not adhere to beneficial medication regimens or fail to schedule follow-up appointments, they might experience worse health outcomes as a <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-7-55">result</a>. </p>
<p><a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-7-55">Our research</a> suggests this distinction – medical maximizing versus minimizing – may be central to solving both problems. </p>
<p>To illustrate why, imagine two 50-year-old men who both experience chronic heartburn. </p>
<p>One is a maximizer who goes to the doctor and receives a prescription medication for his heartburn. At the same visit, he also gets a blood test that suggests that he should be taking a statin for his cholesterol, as well as a blood test to screen for prostate cancer that triggers multiple follow-up tests. </p>
<p>By contrast, the other 50-year-old man is a minimizer who does not go to the doctor when he feels heartburn symptoms. Instead, he adjusts his diet to address the problem. He does not end up taking any medications or getting any medical tests. </p>
<p>In our research, maximizers report that they receive more medical care than people with more minimizing tendencies. For example, maximizers take more prescription medications, visit the doctor more frequently, are more likely to get vaccines and blood draws, and have even had more overnight hospital stays in the past 10 years, as compared to minimizers. These associations exist even though maximizers do not tend to be sicker than minimizers and are just as likely to report having health insurance. </p>
<p>When there is a choice to be made between doing more versus doing less, maximizers will probably push for more, whereas minimizers will be satisfied to do less. Maximizers often opt for more active treatment interventions. For example, maximizers are more likely to say they would prefer surgery over physical therapy for treatment of back pain, or chemotherapy over palliative care for end-stage cancer. </p>
<h2>Is it better to be a maximizer or a minimizer?</h2>
<p>It might seem like people who receive more medical care will be healthier, because they take care of health issues before they become big problems. However, there is increasing evidence that <a href="https://jhupbooks.press.jhu.edu/content/ending-medical-reversal">a lot of medical care that people receive provides minimal benefit and can even cause harm</a>. </p>
<p>Let’s return to our two 50-year-old men. The maximizer might be better off because his heartburn symptoms and cholesterol levels are being actively treated. However, the minimizer might have improved his heartburn symptoms or even his cholesterol-related risks without chancing any side effects from medications. Moreover, <a href="https://academic.oup.com/jnci/article/102/9/605/894608/Overdiagnosis-in-Cancer">research indicates</a> that screening for prostate cancer often does more harm by leading to overdiagnosis – that is, diagnosis and treatment of cancers that will never grow or spread. Thus, the maximizer might experience a variety of physical and emotional problems related to his prostate cancer screening test that the minimizer simply avoided.</p>
<p>Your preference for maximizing or minimizing can be either beneficial or not, depending on the situation. The drawback of being a minimizer is that you might delay getting care that you need. The drawback of being a maximizer is that you may get care (and spend money) that you didn’t need to, and which may cause more harm than good. </p>
<p>We hope that identifying variations in maximizing or minimizing tendencies may be useful in trying to address both overuse and underuse in health care. Physicians could use the minimizer-maximizer distinction to guide conversations with patients about necessary versus unnecessary care. Also, health communications could be targeted to address the concerns of maximizers, who may often want more care than what is necessary, and minimizers, who may not act to get the care that they need.</p><img src="https://counter.theconversation.com/content/73825/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Scherer receives funding from the National Science Foundation. </span></em></p><p class="fine-print"><em><span>Brian Zikmund-Fisher receives funding from the U.S. Agency for Healthcare Research and Quality, the U.S. Department of Veterans Affairs, the U.S. National Science Foundation, and the U.S. National Cancer Institute.</span></em></p>Just about everyone wants medical care, but some want it a lot more. We discovered a personality trait that explains why it’s hard to improve health care outcomes and costs.Laura Scherer, Assistant Professor, Psychology, University of Missouri-ColumbiaBrian J. Zikmund-Fisher, Associate Professor of Health Behavior and Health Education, Interim Co-Director of the Center for Bioethics and Social Sciences in Medicine, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/748902017-03-23T01:06:02Z2017-03-23T01:06:02ZHow a study about Chronic Fatigue Syndrome was doctored, adding to pain and stigma<figure><img src="https://images.theconversation.com/files/161665/original/image-20170320-9132-rd2gxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dr. Ellen Wright Clayton, who has worked with those who have Chronic Fatigue Syndrome, spoke to an open committee at the Institute of Medicine in February 2015 about the biomedical nature of CFS. </span> <span class="attribution"><span class="source">Susan Walsh/AP</span></span></figcaption></figure><p>The public relies on scientists to report their findings accurately and completely, but that does not always happen. Too often, researchers announce only their most favorable outcomes, while keeping more disappointing results <a href="http://www.chronicle.com/article/Spoiled-Science/239529">well out of sight</a>. </p>
<p>This phenomenon, first identified by the psychologist <a href="http://psycnet.apa.org/journals/bul/86/3/638">Robert Rosenthal</a> in 1979, is called the “file drawer problem.” Although it is widely recognized – affecting <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1257776/">drug trials</a>, <a href="http://www.psychfiledrawer.org/TheFiledrawerProblem.php">psychology</a> experiments and most other fields – it has seldom been documented, for obvious reasons. Suppressed results are, well, suppressed, and they are usually discovered only by chance.</p>
<p>It was therefore almost unprecedented when a group of patients, at the end of last year, successfully <a href="https://www.statnews.com/2016/09/21/chronic-fatigue-syndrome-pace-trial/">unmasked the skewed data</a> behind an <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/abstract">influential British study</a>, first published in Lancet in 2011, of the devastating disease known as Chronic Fatigue Syndrome (sometimes called myalgic encephalomyelitis or ME/CFS). </p>
<p>My interest in this issue is both professional and personal. As a law professor, I have devoted much of my career to the study of judicial ethics, including the problem of implicit biases that can undermine the reliability of both <a href="http://journals.sagepub.com/doi/full/10.1177/1359105317697324">court trials and clinical trials</a>. </p>
<p>I have also been living with ME/CFS for over a decade, so I am acutely attuned to the need for responsible and transparent research on the illness. Unfortunately, the most extensive study of ME/CFS – called the <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/abstract">PACE trial</a> – was deeply flawed from its inception, in ways that the principal investigators have yet to acknowledge. </p>
<h2>‘Dysfunctional’ beliefs all too real for those in pain</h2>
<p>The story began in 2005, when a group of psychiatrists set out to test their theory that ME/CFS is primarily a psychosocial illness, characterized by patients’ <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/abstract">“unhelpful cognitions”</a> and their <a href="http://www.virology.ws/2015/10/21/trial-by-error-i/">“dysfunctional”</a> beliefs that their symptoms are caused by an organic disease. </p>
<p>Under this assumption, they recruited over 600 ME/CFS patients for the PACE trial and randomly divided them into four categories. One group was treated with cognitive behavior therapy (CBT), a form of psychotherapy that addresses patients’ “false perceptions” of their illness, and a second group received graded exercise therapy (GET), which consisted of supervised increases in their activity levels. The other two groups were essentially controls, receiving neither of the treatments under study. </p>
<p>In a 2013 article in <a href="https://www.ncbi.nlm.nih.gov/pubmed/23363640">Psychological Medicine</a>, the PACE team announced its most striking results. This follow-up article claimed that the therapy arms of the study – CBT and GET – had achieved impressive 22 percent recovery rates – not just improvement rates – as opposed to only seven or eight percent in the control arms. </p>
<p>The result was <a href="http://www.sciencemediacentre.org/expert-reaction-to-new-research-into-therapies-for-chronic-fatigue-syndromeme/">enthusiastically promoted</a> in the press, but many patients were suspicious, especially of the GET outcomes, which contradicted their experience of debilitating crashes following the simple movements of daily life.</p>
<p>ME/CFS patients have consistently explained that <a href="http://www.slate.com/articles/health_and_science/medical_examiner/2015/11/chronic_fatigue_pace_trial_is_flawed_should_be_reanalyzed.html">exertion exacerbates</a> their worst symptoms. For many, even moderate exercise can result in a days-long crash, in which they are nearly immobilized by muscle weakness and joint pain. In the U.S., post-exertional relapse has been recognized as the <a href="https://www.ncbi.nlm.nih.gov/pubmed/25695122">defining characteristic</a> of the illness by the Centers for Disease Control, the National Institutes of Health and the Institute of Medicine. </p>
<p>For the PACE investigators, however, the announced recovery results validated their conviction that psychotherapy and exercise provided the key to reversing ME/CFS. </p>
<p>There was just one problem. A <a href="http://www.virology.ws/2015/10/21/trial-by-error-i/">subsequent investigation</a> found that the PACE investigators had <a href="https://www.nytimes.com/2017/03/18/opinion/sunday/getting-it-wrong-on-chronic-fatigue-syndrome.html?_r=0">changed</a> the standard for recovery midstream, weakening one of the key criteria to the point that a subject could actually have gotten worse in the course of the trial and yet still count as “recovered” following supervised GET. </p>
<h2>Unraveling the mystery</h2>
<p>Here is how it worked, as shown by the investigation: At the outset of the trial, patients were recruited who scored at 65 or lower on a measure called the physical function score, and recovery was defined as achieving a subsequent score of 85 or higher, which indicates a relatively healthy person. </p>
<p>Before the unblinded trial was completed, however, the definition of recovery was <a href="http://journals.sagepub.com/doi/full/10.1177/1359105316675213">reduced to a score of 60</a>, which was below the level that qualified research subjects in the first place. </p>
<p>It was the change in this outcome measure <a href="http://www.senseaboutscienceusa.org/pace-research-sparked-patient-rebellion-challenged-medicine/">(and several others)</a> that allowed the PACE researchers to declare their favorable outcome for GET. The unimpressive results under the original protocol went <a href="https://theconversation.com/tribunal-was-right-to-order-release-of-chronic-fatigue-trial-data-64255">unpublished</a>, as though they had been stuck in a a figurative file drawer. </p>
<p>When the Psychological Medicine article was published in 2013, members of the patient community immediately pointed out the discrepancy. Because the study had been publicly funded, they sought the underlying data under the U.K.’s Freedom of Information law. The PACE investigators refused to release any of the raw results.</p>
<p>In October 2015, David Tuller of the University of California at Berkeley published a lengthy <a href="http://www.virology.ws/2015/10/21/trial-by-error-i/">expose</a> of the PACE trial, pointing out the jiggered outcome measure, as detailed above, and many other flaws. His report attracted the attention of numerous American scientists who joined an <a href="http://www.virology.ws/2016/09/06/open-letter-to-queen-mary-university-london-about-pace/">open letter</a> seeking an independent review of the PACE data. </p>
<p>Finally, in summer 2016, a British Freedom of Information tribunal <a href="https://theconversation.com/tribunal-was-right-to-order-release-of-chronic-fatigue-trial-data-64255">ordered</a> the PACE team to unlock the file drawer and disclose their raw data. A revelation followed. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/161903/original/image-20170321-5397-srcg1i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/archives-magnifier-3d-557199121?src=oyv2P5wFiTaNIEWuemcUZA-1-1">From www.shutterstock.com</a></span>
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<h2>Exaggerated recovery claims</h2>
<p>A group of patients and scholars reanalyzed the PACE data according to the original determinants and, as suspected, the “recoveries” under CBT and GET all but disappeared. As they reported last December in a peer-reviewed <a href="http://www.tandfonline.com/doi/full/10.1080/21641846.2017.1259724">medical journal</a>, the recovery rate for CBT fell to seven percent and the rate for GET fell to four percent, which were statistically indistinguishable from the three percent rate for the untreated controls. </p>
<p>Thus, the PACE investigators proved nothing more than a familiar adage among statisticians: If you torture the data, they will confess anything. </p>
<p>Researchers in the U.S. and Australia have recently made great progress toward <a href="https://www.healthrising.org/blog/2017/02/28/biomarker-aussies-chronic-fatigue-syndrome/">identifying biomarkers </a>for ME/CFS, which may lead to an effective medical intervention. Over 100 prominent researchers, clinicians and organizations have called on Psychological Medicine <a href="https://www.statnews.com/2016/09/21/chronic-fatigue-syndrome-pace-trial/">to retract </a>the PACE article, although the journal has not yet publicly responded. </p>
<p>Thanks to the original PACE announcement, however, graded exercise is still routinely prescribed throughout the U.S. and the U.K. despite reports that the treatments can cause intolerable pain and relapse. Those who question GET are often told that they must simply exercise more, no matter how badly they crash afterward. </p>
<p>It is bad enough to torture the data, but it is indefensible to torture patients based on manipulated results.</p><img src="https://counter.theconversation.com/content/74890/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Lubet does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A study that suggested Chronic Fatigue Syndrome was more psychological than physical has been debunked. How did the data get doctored?Steven Lubet, Williams Memorial Professor of Law, Northwestern UniversityLicensed as Creative Commons – attribution, no derivatives.